340B Drug Pricing Program Database
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PHARMASCRIPT INC.
RWI17 HILLSBOROUGH COUNTY HEALTH DEPT
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Covered Entity Details
Entity Name
HILLSBOROUGH COUNTY HEALTH DEPT
Subdivision Name
Type
Ryan White Part A
340B ID
RWI17
Entity Address
1105 E. KENNEDY BLVD
ROOM 101 ANNEX
TAMPA, FL 33602
Grant Number
H89HA00024
Participating Start Date
4/1/1997
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
PHARMASCRIPT INC.
Pharmacy Address
5437 N. BROADWAY AVENUE
CHICAGO, IL 60640-1703
Pharmacy Comments
Contract Details
Approval Date
10/12/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/6/2023
Agreement registered in error
Contacts
Covered Entity Signing Official
Gisela Hernandez, Director of Nursing
(813) 559-4270
Contract Pharmacy Representative
Pharmascript
Maricela Kim, 340B Representative
(773) 681-0965
Signed By Date
10/12/2020
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